Antiplatelet agents for chronic kidney disease

Antiplatelet therapy appears to lower the risk of myocardial infarction but increase major bleeding in people with chronic kidney disease. It may not reduce total or cardiovascular mortality or stroke.

The quality of evidence is downgraded by study limitations (unclear allocation concealment and selective outcome reporting).

Summary

A Cochrane review included 50 studies with a total of 27 139 subjects; 44 studies (n=21 460) compared an antiplatelet agent with placebo or no treatment, and 6 studies (n=5 679) directly compared one antiplatelet agent with another. Compared to placebo or no treatment, antiplatelet agents reduced the risk of myocardial infarction (RR 0.87, 95% CI 0.76 to 0.99; 17 studies), but not all-cause mortality (RR 0.93, 95% CI 0.81 to 1.06; 30 studies), cardiovascular mortality (RR 0.89, 95% CI 0.70 to 1.12; 19 studies) or stroke (RR 1.00, 95% CI 0.58 to 1.72; 11 studies). Antiplatelet agents increased the risk of major (RR 1.33, 95% CI 1.10 to 1.65; 27 studies) and minor bleeding (RR 1.49, 95% CI 1.12 to 1.97; 18 studies). In terms of dialysis access outcomes, antiplatelet agents reduced access thrombosis or patency failure but had no effect on suitability for dialysis. Limited data were available for direct head-to-head comparisons of antiplatelet drugs, treatment in kidney transplant recipients, primary prevention, or risk of end-stage kidney disease.

Clinical comments

Risks may outweigh benefits among people with low annual risks of cardiovascular events, including those with early stages of chronic kidney disease who do not have clinically-evident occlusive cardiovascular disease.

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Ədəbiyyat

1. Palmer SC, Di Micco L, Razavian M et al. Antiplatelet agents for chronic kidney disease. Cochrane Database Syst Rev 2013;(4):CD008834.